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Individual
DR. JACKIE D NICKSON
Active
Individual
DR. JACKIE D NICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
MS
225100000X
Physical Therapist
—
MS
225200000X
Physical Therapy Assistant
—
MS
225X00000X
Occupational Therapist
1986
MS
225X00000X
Occupational Therapist
Primary
OT1986
MS
235Z00000X
Speech-Language Pathologist
—
MS
Other
Enumeration date
09/20/2013
Last updated
01/12/2014
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